Category Archives: Soft Tissue and Dentoalveolar Injuries

lacerations
The general guidelines for management of facial lacerations are outlined in Chapter 23 ..Frequently, fractures of the facial bones are associated with severe facial lacerations. The principles of laceration repair remain’ the same
regardless of how small or large the injury.
ftG. 24-31 A, Patient (who ‘sustalned severe pantacial trauma from an industrial accident) in theoperating departme

Midface Fractures
Treatment of fractures of the midface can be divided into those fractures that affeci, the occlusal relationship, such as Le Fort I, IC or III fractures, and those fractures that do not necessarily affect the occlusion, such as fractures
of an isolated zygoma, zygomatic arch, or NO[‘ complex.
Suspension ·wiring is sometimes used in addition to direct wiring or bone plating. The purpose

Mandibular Fractures
The first and most important aspect of surgical correction is to reduce the fracture properly or place the individua segments of the fracture into the proper relationship with
FIG 24-17
each other. In the proper reduction of fractures of toothbearing bones, it is most important to place the teeth into the preinjury occlusal relationship. Merely aligning’ and interdigitattng-rhc bony

TREATMENT Of FACIAL FRACTURES
Whenever facial structures are injured, treatment must be directed toward maximal rehabilitation of the. patient . For facial fractures, treatment goals include rapid bone, healing; a return of normal ocular. masticatory; and nasal
function; restoration of speech; and an acceptable facial . and dental esthetic result. During the treatment and healing phases, it is also important

Midface Fractures
Midfacial fractures inciude fractures affecting the maxilla, the zygoma, and the NOE complex. Midfacial fractures can be classified as Le Fort I, II, or III fractures, zygomaticomaxillary complex (ZMC) fractures, zygomatic arch fractures, or NOE fractures. These injuries may be isolated or occur
in combination.
The most common type of midfacial fracture is the zygomatic complex fracture (Fig.

Mandibular Fractures
Depending on thetype of injury and the direction and force of the trauma, fractures of the mandible commonly occur in several locations. One classification of fractures
FIG. 24-11 Anatomic distribution of mandibular fractures. (From Olson RA et 0/:Fractures of the mandible: a reviev« of 580 cases, J Oral Maxillofac Surg 40:23,1982.)
FIG. 24-12 Types of mandible fractures classified according

CAUSE AND CLASSIFICATION OF FACIAL FRACTURES
Causes of Facial Fractures
accidents are far more frequent in people who were not wearing ~estraints at the time of the accident . The major causes of facial fractures include motor vehicle accidents and altercations. Other causes of injuries include falls, sports-related :!~<‘i{I”l1t~. and work-related accldents.v’ Facial fractures resulting f

Radiographic Evaluation
After a careful clinical assessment of the facial area, radiographs should be taken to. provide additional information about facial injurles.? In cases of severe facial trauma, cervical spine injuries should be ruled out with a
complete cervical spine series (i.e., cross-table,’ odontoid, and obliques views) befote any manipulation of the neck. The facial radiographic examination&

History and Physical Examination
After the patient has been initially stabilized, as complete a history as possible should be obtained. This history should be obtained from the patient; however, because of loss of consciousness or impaired neurologic status, information must often be obtained from witnesses or accompanying
family members. Five important questions should be considered: (1) How did the accident

Immediate Assessment
Before completing a detailed history and physical evaluation of the facial area, critical injuries that may be life threatening must be addressed. The first stein evaluar ing a trauma patient is to assess the patient’scardiopular,stability by ensuring that the patient has a patent airway andis adequately ventilated. Vital signs, including respiratory and pulse rates and blood pressur